Corporate Infrastructure and Regulatory Services Scrutiny Committee & Health and Adult Care

Scrutiny Committee

Problem Gambling

Spotlight Review

September 2018

1. RecommendationsThe Task Group ask the Corporate Infrastructure and Regulatory Services Scrutiny Committee, Cabinet, The Police and the NHS in Devon to endorse the report and recommendations below; with a report on progress against the recommendations in twelve months time.

Ambition Specific recommendations Agency

1.1Request that the Health and Wellbeing Board undertake work to understand the interrelation between gambling and people with other complex needs. Including consideration of a focus on problem gambling in the Joint Strategic Needs Assessment.

DCC

1.2 Train frontline staff and employers to recognise the risks and warning signs associated with problem gambling. This should include children’s services, youth services, high needs adults, police custody suites and A&E.

DCC, Police, NHS

1 Increase the visibility of the dangers of problem gambling.

1.3 Work with coroners to ensure appropriate use of supplementary codes for gambling as a diagnosable mental health condition (ICD10 F63.0) and lifestyle risk factor (ICD10 Z72.6) in death certification following suicide

1.4Work with local healthcare providers to ensure appropriate use of these codes in healthcare activity relating to self-harm and mental health

1.5Include gambling as a specific risk factor within local suicide audit arrangements

1.6Analyse available data to identify local patterns and associated risks to inform service planning and targeting

2.1 Record how many people who come into contact with our collective services who do identify as having a gambling problem.

DCC2 Understand the scale of the problem by collaborating on insight and intelligence with partners. 2.2 Share information to enable the creation of

area maps which highlight areas of concern to inform planning or resource allocation.

DCC, Districts, Gambling charities

Ambition Specific recommendations Agency

3.1Raise awareness of GamCare certification DCC/ Districts

3.2Write to government to request that credit cards are not used online.

DCC

3 Continue to support responsible gambling across sectors.

3.3DCC to take an active role in promoting Responsible Gambling Week through our comms team (1st - 7th Nov)

DCC/ Districts/ Gambling Commission

identify and promote services that offer help for people or families who are suffering from the effects of problem gambling.

NHS – Police, DCC, CAB Exeter University

4 Take action when people need help

Lead by example as responsible employers and ensure that the staff assistance programme is aware of problem gambling and knows how to help people.

DCC

2. Introduction2.1 This Spotlight review was established following concerns from Councillors on problem

gambling. A report by Devon Public Health was presented to the Corporate Infrastructure and Regulatory Services Scrutiny Committee in January 2018, with suggestions from the Scrutiny Team as to how this issue could be constructively reviewed. A spotlight review was determined as the most useful way to review the subject matter.

2.2 Problem Gambling is an issue that more policy makers are attending to. The LGA provided information for the House of Lords last November, and hosted a conference dedicated to this issue in July 2018. In preparation for this work, the Chair of this task group attended the conference. There have also been several national news stories about the dangers of problem gambling, particularly those associated with fixed odds betting1. The Gambling Commission has also been given strengthened powers to regulate more comprehensively (for example, the inclusion of remote gambling in UK regulation).

2.3 Whilst Devon County Council is not responsible for the direct provision of gambling establishments, the impacts of problem gambling are highly likely to have an impact on spend on services for vulnerable people.

2.4 Recognising the role that scrutiny can have in bringing different agencies together to collectively problem solve, the scope of this spotlight review was:

- To understand the underlying causes of problem gambling and the challenges associated with problem gambling.

- To explore the ways in which DCC and partners could work together to prevent people who are at risk of problem gambling reaching crisis point.

- To identify the ways in which DCC and partners could work together to support people in Devon who have gambling addictions.

2.5 The spotlight review took place on the 7th August and was held in the form of a round table discussion with structured questions clustered around three themes:

- Prevention;

- Understanding when gambling becomes a problem;

- Identifying support available when someone is struggling with problem gambling.

2.6 The findings of the review were particularly focused around the need for reliable and accurate data. Several of the partners in the room committed to working together to better understand the scale of the problem as well as to support services that exist to help people with a gambling addiction.

1 The Guardian ‘UK betting firms face complaints deadline and ads crackdown’ https://www.theguardian.com/society/2018/aug/01/uk-betting-firms-face-complaints-deadline-and-ads-crackdown 1st Aug 2018

20% of problem drinkers receive treatmentbut only2% of problem gamblers receive treatment

3. The Gambling Industry

3.1 There are a number of different ways that people gamble, these include the National Lottery, in betting shops, bingo halls or casinos as well as online. Gambling is a popular past time; 45% of people have gambled in the past four weeks. More men than women gamble (48% compared to 41%) 2 People aged 55-64 are the most likely to gamble, however this is heavily influenced by participation in the National Lottery. If this is excluded, gambling participation is highest among 16-34 year olds3. Most people gamble responsibly as a leisure activity with no adverse effects.

3.2 The gambling industry is big business with a gross yield of more than £14 billion a year. (Gross Gambling Yield means the amount of money after winnings have been deducted but before tax and other costs). Roughly a third of the market share is spent online, as demonstrated on the chart below.

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3.3 The spotlight review was particularly concerned about the increasing trajectory of remote gambling, which often takes place online. Eighteen percent of people have gambled online in the past four weeks. The chart below shows the types of games that people play online represented as a proportion of the £4.9 Billion spent:

2 Figures from Gambling Commission http://www.gamblingcommission.gov.uk/news-action-and-statistics/Statistics-and-research/Levels-of-participation-and-problem-gambling/Gambling-participation-and-problem-gambling.aspx 3 Gambling Commission: ‘Gambling participation in 2017: behaviour, awareness and attitudes Annual report’ http://www.gamblingcommission.gov.uk/PDF/survey-data/Gambling-participation-in-2017-behaviour-awareness-and-attitudes.pdf 4 Chart produced by the scrutiny team with information from the Gambling Commission http://www.gamblingcommission.gov.uk/news-action-and-statistics/Statistics-and-research/Statistics/Gambling-key-facts.aspx

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3.4 Gambling online is of particular concern because there are fewer restrictions to limit the amount or the ease of access to funds. Specifically using a credit card is possible online compared to in some gambling premises (e.g. casinos) where credit cards can only be used to credit money to a customer’s account.

3.5 The number of people going to a physical location to gamble is decreasing. The majority of gambling in premises happens in betting shops, and the comparative number of fixed betting premises are shown on the chart below:

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5 Chart produced by the scrutiny team with information from the Gambling Commission http://www.gamblingcommission.gov.uk/news-action-and-statistics/Statistics-and-research/Statistics/Gambling-key-facts.aspx6 Chart produced by the Scrutiny Team with information from the Gambling Commission http://www.gamblingcommission.gov.uk/news-action-and-statistics/Statistics-and-research/Statistics/Gambling-key-facts.aspx

3.6 Fixed odds betting terminals have been a particular growth area for the industry, with the yield rising from £1.05 billion in April 2008 to £1.73 billion in March 2016, representing a 65% increase in eight years7

3.1 There are moves to reduce the maximum stakes on fixed odds betting terminals from the current £100 to £2. This is because the current maximum stake of £100 is significantly out of line with the maximum amounts that can be staked on other types of gaming machines. There is also credible evidence that these machines may be particularly addictive and therefore pose a greater risk to problem gamblers, as well as being linked to anti-social behaviour8.

4. Licencing 4.1 District Councils enforce regulations laid out in the Gambling Act (2005) and oversee

licensing for gambling premises in their area. In 2016 the ‘point of consumption regulation’ was brought in where any person offering remote gambling facilities to British customers must have a license from the Gambling Commission. In partnership with District councils, inspections are carried out by the Gambling Commission to prevent under age gambling and to test gambling outlet staff’s knowledge and understanding of regulations and procedures. The British Amusement Trade Catering Association (BACTA) also provide tests of age verification procedures in outlets and compliance for their members.

4.2 The spotlight review spoke to Licensing Managers from Teignbridge and Plymouth. Teignbridge District Council has 40 licensed gambling premises, which are under strict monitoring. Generally, the service sees small issues (such as not putting stickers on machines, or moving machines so that proprietors could visually supervise them). Importantly no issues surrounding Fixed Odd Betting Terminals (FOBTs) have been brought to Council’s attention.

4.3 Experience from visits undertaken show that generally staff are trained to recognise signs of harmful gambling and that licensed operators provide training on at least an annual basis. The Gambling Commission’s License Conditions and codes of practice require Operators to take appropriate action when they suspect harmful gambling.

4.4 There are increasing regulations around gambling. the Guardian reported that from October the Gambling Commission will have powers to impose unlimited fines for promotional campaigns that appeal to children or glamorise gambling. The watchdog will also introduce an eight-week deadline for operators to resolve complaints with customers.

5. What is Problem Gambling - and why is it a problem?5.1 For a small number of people gambling is not a harmless pastime but a pernicious

addiction that can have serious consequences. The Royal College of psychiatrists defines problem gambling as:

7 Local Government Association Briefing Debate on challenges facing problem gamblers House of Lords Thursday 23 November 2017 https://www.local.gov.uk/sites/default/files/documents/LGABriefing_ProblemGambling_HouseofLords_23Nov17_2.pdf8 Local Government Association Briefing Debate on challenges facing problem gamblers House of Lords Thursday 23 November 2017 https://www.local.gov.uk/sites/default/files/documents/LGABriefing_ProblemGambling_HouseofLords_23Nov17_2.pdf

‘gambling that disrupts or damages personal, family or recreational pursuits.’9

To be more specific signs and symptoms of compulsive gambling (gambling disorder) include:

Being preoccupied with gambling, such as constantly planning how to get more gambling money

Needing to gamble with increasing amounts of money to get the same thrill Trying to control, cut back or stop gambling, without success Feeling restless or irritable when you try to cut down on gambling Gambling to escape problems or relieve feelings of helplessness, guilt,

anxiety or depression Trying to get back lost money by gambling more (chasing losses) Lying to family members or others to hide the extent of your gambling Jeopardizing or losing important relationships, a job, or school or work

opportunities because of gambling Resorting to theft or fraud to get gambling money Asking others to bail you out of financial trouble because you gambled

money away10

5.2

5.3 The impact of gambling is felt more widely than just by the individual who gambles. Problem gambling can impact on individuals and their families’ physical, mental and emotional health and wellbeing as well as having a wider impact on society through crime and disorder. Work is underway to measure and define the impacts of gambling beyond the individual. The diagram on the following page clearly outlines the impact of gambling.

9 https://www.rcpsych.ac.uk/healthadvice/problemsdisorders/problemgambling.aspx 10 Mayo Foundation for Medical Education and Research ‘Compulsive Gambling’ https://www.mayoclinic.org/diseases-conditions/compulsive-gambling/symptoms-causes/syc-20355178

Case Study: Devon County Councillor The Spotlight Review heard from a member of the review group who went on record to share his personal experience of being a problem gambler. Councillor Ian Hall shared his personal experience of having been a problem gambler many years ago. Councillor Hall told the Spotlight Review that he used to play innocuous games with a financial element whilst at school which led to a more serious addiction and a significant deterioration in his mental health as a result. The spotlight review heard how Cllr Hall recovered with his own determination and support from this friends and family. Cllr Hall also shared his experience of knowing peers with similar problems and serious consequences.His reflection was how easy it is to have a competitive game which becomes monetarised, often for very small amounts. This in turn leads to feeling comfortable gambling with higher amounts, often with the promise of a bigger prize and corresponding serious consequences.

- 0.7% of the population are problem gamblers- 3.6% of the population are at risk of developing gambling

problems- 5400 people in Devon are likely to have a gambling problem - 6-10 individuals are affected by each problem gambler.

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11 Measuring gambling-related harms A FRAMEWORK FOR ACTION http://www.gamblingcommission.gov.uk/PDF/Measuring-gambling-related-harms.pdf

Why is gambling addictive?5.4 The psychology of gambling is complex. Developing an addiction is not helped by the

socially acceptable nature of gambling or the low levels of introduction. For example, playing on 2p slot machines or A 10p introductory bet for online gambling.

5.5 The Members of the Spotlight Review were particularly interested in why gambling is addictive. The latest research in neuroscience suggests that the illusion of control is appealing to people who engage in gambling activities. Playing games when there is an interpretation of skill involvement in situations governed entirely by changes makes them more attractive. For example, choosing the numbers that you play with or throwing a roulette ball. These illusions of control foster an emotional relationship with the outcome where the player has a disproportionate expectation of winning12. A recent study using a contingency judgment task from the associative learning literature found that pathological gamblers displayed a greater tendency to overestimate their control of positive outcomes than non-gambling participants.13

Are particular people more at risk?5.6 The Spotlight Review was particularly interested in whether there were specific

characteristics that led people to become problem gamblers. The Chair of the Spotlight Review shared the chart below which demonstrates factors from the individual, families and social networks, community and societal influences that may make it more likely for someone to become a problem gambler:

12 Luke Clark, Bruno Averbeck, Doris Payer, Guillaume Sescousse, Catharine A. Winstanley and Gui Xue: Journal of Neuroscience; ‘Pathological Choice: The Neuroscience of Gambling and Gambling Addiction’6 November 2013, 33 (45) 17617-17623; DOI: https://doi.org/10.1523/JNEUROSCI.3231-13.2013 13 ‘Luke Clark, Bruno Averbeck, Doris Payer, Guillaume Sescousse, Catharine A. Winstanley and Gui Xue: Journal of Neuroscience; ‘Pathological Choice: The Neuroscience of Gambling and Gambling Addiction’6 November 2013, 33 (45) 17617-17623; DOI: https://doi.org/10.1523/JNEUROSCI.3231-13.2013

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14 Measuring gambling-related harms A FRAMEWORK FOR ACTION http://www.gamblingcommission.gov.uk/PDF/Measuring-gambling-related-harms.pdf 15 Pharmacy Pedia: ‘Addiction Gambling (compulsive gambling’ )https://pharmacypedia.org/diseases-and-conditions/addiction-gambling-compulsive-gambling/

Risk factors- Although most people who play cards or wager never develop a gambling problem,

certain factors are more often associated with compulsive gambling:- Mental health disorders. People who gamble compulsively often have substance

abuse problems, personality disorders, depression or anxiety. Compulsive gambling may also be associated with bipolar disorder, obsessive-compulsive disorder (OCD) or attention-deficit/hyperactivity disorder (ADHD).

- Age. Compulsive gambling is more common in younger and middle-aged people. Gambling during childhood or the teenage years increases the risk of developing compulsive gambling. However, compulsive gambling in the older adult population can also be a problem.

- Gender. Compulsive gambling is more common in men than women. Women who gamble typically start later in life and may become addicted more quickly. But gambling patterns among men and women have become increasingly similar.

- Family or friend influence. If your family members or friends have a gambling problem, the chances are greater that you will, too.

- Medications used to treat Parkinson's disease and restless legs syndrome. Drugs called dopamine agonists have a rare side effect that may result in compulsive behaviours, including gambling, in some people.

- Certain personality characteristics. Being highly competitive, a workaholic, impulsive, restless or easily bored may increase your risk of compulsive gambling.

5.7 The Spotlight Review had particular concerns about the link between gambling and suicide. The Chair of the review reported from the LGA conference that 500 suicides a year were directly attributable to gambling. He also shared a case study also from the conference where a man committed suicide after accruing the relatively modest debt of £1400.

6. Support for Problem Gamblers

6.1 There's evidence that gambling can be successfully treated in the same way as other addictions. Cognitive behavioural therapy usually has the best results. Treatment and support groups are available for people who want to stop gambling:

- GamCare GamCare offers free information, support and counselling for problem gamblers in the UK. It runs the National Gambling Helpline (0808 8020 133) and also offers face-to-face counselling.

- National Problem Gambling Clinic If you live in England or Wales, are aged 16 or over and have complex problems related to gambling, you can refer yourself to this specialist NHS clinic for problem gamblers.

- Gordon Moody Association The Gordon Moody Association offers residential courses for men and women who have problems with gambling – email help@gordonmoody.org.uk or call 01384 241292 to find out more. It also runs the Gambling Therapy website, which offers online support to problem gamblers and their friends and family.

- Gamblers Anonymous UK Gamblers Anonymous UK runs local support groups that use the same 12-step approach to recovery from addiction as Alcoholics Anonymous. There are also GamAnon support groups for friends and family.

In Devon there are dedicated support options for people who are suffering with problem gambling, this information is available on pinpoint and is reproduced Appendix 2.

6.2 Only 6% of gamblers have ever self-excluded. Self exclusion is where someone who knows that they have a problem with gambling makes themselves known to a particular gambling outlet to support getting help to stop gambling.

5.8 The spotlight review contacted Exeter University to ask about their provision of support for students at risk of problem gambling. The response was as follows:

‘I can confirm that as a service, we do not offer specific support for gambling problems. We do offer short-term therapies, including Counselling and CBT, and may refer students on to external, specialised support where necessary.

We can consider having your service down as one of our external resources, should we need to refer any students on for such support. Alternatively, please feel free to provide us with details of any other support providers for gambling problems, and we can also consider adding these to our list of external resources.’

5.9 The Spotlight Review will subsequently be sending the service a copy of this report to assist in sign posting support that is available.

7. Conclusion This Spotlight Review brought together partners from Local Authorities, the Police, gambling charities and support organisations and even heard from a company that supplies gambling equipment. The work offers a snapshot view into concerns around problem gambling. As is clear in this report, some people are at a higher risk of suffering serious consequences

Whilst this was a review conducted in a single morning the evidence that the recommendations rest upon is based on significant research from several organisations. Problem Gambling is becoming recognised as a more serious problem than previously. Society’s relationship with gambling can be problematic as it is widely accepted, and many people undertake and enjoy gambling without significant ramifications. However, this may mask the seriousness and speed of potential harm to those to whom gambling does present a problem. The potential consequences from increasingly easy to access gambling websites can very quickly add up to significant debt. It is intended that the recommendations in this report will support increased recognition of the dangers, as well as supporting a multi-agency approach to prevent problem gambling and better signposting and awareness of support that does exist.

8. Sources of evidence

Witnesses The Task Group heard testimony from a number of sources and would like to express sincere thanks to the following for their involvement and the information that they have shared as well as to express a desire of continuation of joint work towards the fulfilment of the recommendations in this document.

Name Role Organisation

Steve Brown Deputy Director of Public Health Devon County Council

Kristian Tomblin Commissioning Manager, Public Health

Devon County Council

Richard Nokes Compliance Manager – South West England

The Gambling Commission

Rachael Hind Licensing Service Manager Plymouth City Council

Anna Hemmings(via video call)

CEO GamCare

Matt Baxter Inspector Devon and Cornwall Police

Simon Atkinson Director Tamar Gaming

Andrea Furniss Licencing Services manager Teignbridge District Council

Rob Hayward Public Health Specialist Devon County Council

Thanks also to Philip Bridge from the Democratic Services and Scrutiny Secretariat for organisation supporting this Spotlight Review.

Bibliography ‘National Responsible Gambling Strategy’ 2016 Gambling Commission: ‘Gambling participation in 2017: behaviour, awareness and

attitudes Annual report’ http://www.gamblingcommission.gov.uk/PDF/survey-data/Gambling-participation-in-2017-behaviour-awareness-and-attitudes.pdf

Local Government Association Briefing Debate on challenges facing problem gamblers House of Lords Thursday 23 November 2017 https://www.local.gov.uk/sites/default/files/documents/LGABriefing_ProblemGambling_HouseofLords_23Nov17_2.pdf

Luke Clark, Bruno Averbeck, Doris Payer, Guillaume Sescousse, Catharine A. Winstanley and Gui Xue: Journal of Neuroscience; ‘Pathological Choice: The Neuroscience of Gambling and Gambling Addiction’6 November 2013, 33 (45) 17617-17623; DOI: https://doi.org/10.1523/JNEUROSCI.3231-13.2013

The Guardian ‘UK betting firms face complaints deadline and ads crackdown’ https://www.theguardian.com/society/2018/aug/01/uk-betting-firms-face-complaints-deadline-and-ads-crackdown 1st Aug 2018

Mayo Foundation for Medical Education and Research ‘Compulsive Gambling’ https://www.mayoclinic.org/diseases-conditions/compulsive-gambling/symptoms-causes/syc-20355178

Measuring gambling-related harms A FRAMEWORK FOR ACTION http://www.gamblingcommission.gov.uk/PDF/Measuring-gambling-related-harms.pdf

9. Spotlight Review MembershipThe Group was chaired by Councillor Alistair Dewhirst and membership of the Spotlight Review was as follows:

Corporate Infrastructure and Regulatory Services

Health and Adult Care

Councillor Polly Colthorpe Councillor Sara Randall Johnson

Councillor Ian Hall Councillor Andrew Saywell

Councillor Hilary Ackland Councillor Marina Asvachin

Councillor Ray Bloxham

Councillor Colin Slade

10. ContactFor all enquiries about this report or its contents please contact

Camilla de Bernhardt Lane, Head of Scrutiny Cam.debernhardtlane@devon.gov.uk

Appendix 1: NHS checklist to identify problem gambling

Are you a problem gambler?

Try this questionnaire:

Do you bet more than you can afford to lose?

Do you need to gamble with larger amounts of money to get the same feeling?

Have you tried to win back money you have lost (chasing losses)?

Have you borrowed money or sold anything to get money to gamble?

Have you wondered whether you have a problem with gambling?

Has your gambling caused you any health problems, including feelings of stress or anxiety?

Have other people criticised your betting or told you that you had a gambling problem (regardless of whether or not you thought it was true)?

Has your gambling caused any financial problems for you or your household?

Have you ever felt guilty about the way you gamble or what happens when you gamble?

Score 0 for each time you answer "never" Score 1 for each time you answer "sometimes" Score 2 for each time you answer "most of the time" Score 3 for each time you answer "almost always"

If your total score is 8 or higher, you may be a problem gambler.

https://www.nhs.uk/live-well/healthy-body/gambling-addiction/

Appendix 2 help in the South WestFREE Counselling for those affected by Gambling

Covering Dorset, Devon, Somerset and Plymouth

Gambling Counselling ServiceIn partnership with GamCare, Steven James Counselling provides specialist free counselling service for anyone suffering with a gambling problem or friends and family members affected by someone else’s gambling.

We offer one to one counselling with experienced and specialist trained counsellors, who will create a confidential, non-judgemental and nurturing environment in which you can be given the time and support to tackle your gambling problem.

The main aims of our gambling counselling are to help you to:Stop or reduce the frequency of problem gamblingDevelop ways of coping with problem gambling behaviourAddress related issues that are causing harm or damageUnderstand some of the underlying reasons why gambling has become a problemDevelop a productive and healthy life without problem gambling

We offer you an initial assessment appointment with one of our experienced counsellors. Like the rest of our service, this is free. At your assessment we will discuss your situation with you and suggest ways in which you might begin to address your problem. We can then offer you a series of counselling sessions which can be arranged for a regular time and location to suit you.

Although our main office is based in Poole, we have a network of counsellors covering Dorset, Devon, Somerset and Plymouth areas.

Call Steven James Counselling on 01202 740044, to find out more or set up an initial appointment

Remember, this service is also available free as a support for those friends or family members affected by a problem gambler